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Tretinoin (see Important Safety Information) can be an effective treatment for mild to severe acne and a potent tool for reducing the appearance of fine lines and wrinkles. But you can’t find it over the counter. You’ll need to consult a dermatologist or another healthcare provider to find out if this topical treatment is right for you—and, if so, which strength and formulation suits your skin best.
Below, you’ll find a tretinoin strength chart as well as some reasons why healthcare providers may prescribe this powerful and effective retinoid.
What is tretinoin?
Tretinoin has been used for skin conditions for years by helping to increase the cellular turnover of the skin. Topical tretinoin is a prescription (Rx) medication (meaning, it’s not available over the counter) that the FDA approved in 1971 to treat acne.
It belongs to a class of drugs called retinoids or vitamin A analogs. While there are retinoids like retinol that are available over the counter (more on those later), they are not as effective as prescribed retinoids like tretinoin. Tretinoin is thought to be about 20 times more potent than retinol (FDA, n.d.; Zasada, 2019).
When applied to the skin, tretinoin influences the behavior of skin cells—including what the cells do, how quickly they should grow, and when they should die.
Tretinoin cream uses
Typically applied once a day in the evening, tretinoin enhances skin cell turnover, and it also helps your body boost collagen production, which is the main structural component of your skin (Yoham, 2021).
This is why healthcare providers commonly prescribe tretinoin to treat acne and why it’s used to help improve the appearance of sun-damaged skin (also called photoaging). Specifically, tretinoin may help reduce the appearance of fine lines, texture changes, and hyperpigmentation (areas of skin darker in tone than your surrounding skin).
Topical tretinoin comes in a range of strengths, with the lowest strength being 0.01%. The strongest tretinoin available is 0.1%—that’s 10 times stronger than the lowest percentage. But no matter the strength, all percentages of tretinoin require a healthcare provider’s prescription (FDA, n.d.).
To figure out which product or strength you need, consult a healthcare provider. They’ll be able to take a closer look at your skin and determine what the best tretinoin product is for you.
The following chart summarizes key information about tretinoin:
Several combination products contain tretinoin along with other ingredients. Examples include (FDA, n.d.):
- Tri-Luma cream (fluocinolone, hydroquinone, tretinoin), a treatment for facial melasma (dark spots)
- Twyneo cream (benzoyl peroxide, tretinoin), an acne treatment
- Ziana gel (clindamycin phosphate, tretinoin), also an acne treatment
Highest over-the-counter retinoid concentration
Tretinoin’s cousin, adapalene (brand name: Differin), is the first over-the-counter retinoid approved by the FDA to treat acne. Off-the-shelf Differin Gel comes in one strength of 0.1%. A higher strength (0.3%) of adapalene is also available but requires a prescription (Tolaymat, 2022).
Adapalene and tretinoin both belong to the retinoid drug class. Adapalene may also be used off-label to treat signs of aging and sun damage such as fine lines, eye-area wrinkles (“crow’s feet”), dark spots, and rough skin texture (Rusu, 2020; Bagatin, 2018).
Strongest over-the-counter retinol?
Retinols and retinoids are both derived from vitamin A, but they aren’t the same thing. The FDA has not approved retinol in any strength to treat acne or other skin conditions.
Many OTC skincare products contain retinol or retinyl esters, such as retinyl acetate and palmitate, but it isn’t clear which specific product is the highest strength (Zasada, 2019).
The FDA does not strictly regulate cosmetic skincare products that contain retinol. So, manufacturers aren’t required to disclose ingredients’ strengths on the product label (AAD, 2021). A study of various OTC cosmetics revealed that most of these products contain either retinol or retinyl palmitate at concentrations up to 2.2% (Hubinger, 2009).
The optimal or highest strength of retinol is not known. If you are struggling to find effective OTC products for your skin concerns, consider consulting a skincare professional, like a dermatologist. They may recommend a prescription-only retinoid like tretinoin.
Tretinoin vs. retinol: which is better for your skin?
Side effects of tretinoin
Common side effects of tretinoin, particularly in the first few weeks, include (Yoham, 2021):
- Skin irritation
- Burning or stinging
- Redness or discoloration, depending on your natural skin tone
- Photosensitivity (increased sensitivity to sunlight)
- Sensitivity to cold temperatures or windy weather
- New or worse-than-usual acne breakouts in early weeks of use
These side effects may be worse in people with sensitive skin.
Best daily retinoid regimen
It’s recommended to stick to a skincare routine when using retinoids. Apply tretinoin in only a thin layer and only to clean skin that’s dried completely after washing.
Then, the next morning wash your face with a gentle cleanser. Because tretinoin brings newer and more delicate skin to the surface, you also need to protect your skin from sunlight, which means avoiding excessive sun exposure and using sunscreens with an SPF 30+ or higher.
Your healthcare provider will give you instructions based on the strength of the tretinoin product they prescribe. Depending on why you’re using tretinoin, providers may prescribe the lowest strength of tretinoin to start. They may also recommend starting with the microsphere formulation of tretinoin gel, Retin-A Micro. This formulation may cause less skin irritation than tretinoin cream because the gel formulation allows the medication to release into the skin more slowly (DailyMed, 2017).
Aging skin: causes, procedures and anti-aging skincare
It can take weeks, sometimes months, of continuous treatment to see the full benefits of retinoids. At this point, if you’re tolerating the medication well but not seeing improvement, your healthcare provider may increase you to a higher strength of tretinoin.
- American Academy of Dermatology (AAD). (2021). Retinoid or retinol? Retrieved on May 19, 2022 from https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/retinoid-retinol
- Bagatin, E., Gonçalves, H. S., Sato, M., et al. (2018). Comparable efficacy of adapalene 0.3% gel and tretinoin 0.05% cream as treatment for cutaneous photoaging. European Journal of Dermatology, 28(3), 343–350. doi:10.1684/ejd.2018.3320. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30105991/
- DailyMed. (2017). Retin-A Micro – tretinoin gel. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=08ab7e0c-1437-455f-815c-98904d96a289
- Hubinger, J. C. (2009). Determination of retinol, retinyl palmitate, and retinoic acid in consumer cosmetic products. Journal of Cosmetic Science, 60(5), 485–500. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19822106/
- Rusu, A., Tanase, C., Pascu, G. A., et al. (2020). Recent advances regarding the therapeutic potential of adapalene. Pharmaceuticals, 13(9), 217. doi:10.3390/ph13090217. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558148/
- Tolaymat, L., Dearborn, H., & Zito, P.M. (2022). Adapalene. StatPearls. Retrieved on May 19, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK482509/
- US Food and Drug Administration (FDA). (n.d.) Drugs@FDA: FDA-approved drugs. Retrieved on May 19, 2022 from https://www.accessdata.fda.gov/scripts/cder/daf/
- Yoham, A. & Casadesus, D. (2021). Tretinoin. StatPearls. Retrieved on May 19, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK557478/
- Zasada, M. & Budzisz, E. (2019). Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments. Advances in Dermatology and Allergology, 36(4), 392–397. doi:10.5114/ada.2019.87443 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791161/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.